Healthcare Provider Details
I. General information
NPI: 1992975502
Provider Name (Legal Business Name): DOCTORS OFFICE OF DUBLIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6905 HOSPITAL DR STE 200
DUBLIN OH
43016-9600
US
IV. Provider business mailing address
PO BOX 3731
DUBLIN OH
43016-0374
US
V. Phone/Fax
- Phone: 614-766-2220
- Fax:
- Phone: 614-766-2220
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 34003964 |
| License Number State | OH |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QA0000X |
| Taxonomy | Adolescent Medicine (Family Medicine) Physician |
| License Number | 34003964 |
| License Number State | OH |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QA0505X |
| Taxonomy | Adult Medicine Physician |
| License Number | 34003964 |
| License Number State | OH |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QG0300X |
| Taxonomy | Geriatric Medicine (Family Medicine) Physician |
| License Number | 34003964 |
| License Number State | OH |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208D00000X |
| Taxonomy | General Practice Physician |
| License Number | 34003964 |
| License Number State | OH |
VIII. Authorized Official
Name: DR.
MADELYN
RENEE
SARTAIN
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 614-766-2220